A presentation of

COMMUNITY BASED REHABILITATION FORUM A presentation of

An introduction to Community Based Rehabilitation of Persons with Disabilities based on the joint position paper 2004: ILO, WHO and UNESCO C B R Mr. Nicholas Guia RebeloCBR Forum, Bangalore, India

The emergence of the concept ofCommunity Based Rehabilitation “If you give a person a fish, he’ll eat for a day; if you teach him to fish, he’ll eat for a lifetime.”

Community Based Rehabilitation (CBR) brings rehabilitation know-how to villages and urban slums, and CBR personnel facilitate people to take responsibility for their own lives! The process of CBR as the name implies, has to have its roots in the community and has to derive sustenance and support from the community.

WHAT IS CBR? WHAT CBR is a systematized approach within general community development whereby Persons with Disabilities are enabled to live a fulfilling life within their own community, making maximum use of local resources and helping the community become aware of it’s responsibility in ensuring the inclusion and equal participation of PWDs. In the process, PWDs are also made aware of their own role and responsibility, as they are part of the community.

The Joint position paper defines CBR as: • “a strategy within general community development for therehabilitation, equalization of opportunities and social inclusion ofall people with disabilities.” • CBR is implemented through the combined efforts of PWDs themselves, their families, organizations and communities, and the relevant governmental and non-governmental health, education, vocational, social and other services.

What do we see in the picture? Your Boat Mainstream Side stream ? What if you are in the Mainstream? What if you are in the Side stream?

Mainstreaming and inclusion • Mainstreaming and inclusion is seen as an effective way:(a) to include persons with disability (b) to give equal opportunities and (c) to provide a non-discriminative environment for their growth and development. • In practical terms this means persons with disability are included in the programmes and schemes formulated by the government and others, not as mere beneficiaries but as equal members who can participate with full recognition and exercise their rights. Source: Mainstreaming Disability, ADD

Major Objectives The major objectives of CBR as listed in the joint position paper are: • To ensure that PWDs are able to maximize their physical and mental abilities, to access regular services and opportunities, and to become active contributors to the community and society at large. • To activate communities to promote and protect the human rights of PWDs through changes within the community, for example, by removing barriers to participation.

Disability is no longer viewed as merely the result of impairment. • The social model of disability has increased the awareness that environmental barriers (attitudinal, physical and institutional) to participation impede the functioning of PWDs as equals. Evolution of Concepts in CBR • Disability and Rehabilitation

Professionals (medical and other) who provide rehabilitation services have the responsibility to provide relevant information to PWDs / their families so that they can make informed decisions to enable them to lead a fulfilling life. Evolution of Concepts in CBR • Disability and Rehabilitation

CBR promotes the rights of PWDs to live as equal citizens within the community, to enjoy health and well being,to participate fully in educational, social, cultural, religious, economic and political activities. Evolution of Concepts in CBR • Human Rights

There is a strong correlation between disability and poverty. • Poverty leads to increased disability, and disability in turn leads to increased poverty. Evolution of Concepts in CBR • Poverty

In 2000, the UN Member States adopted the Millennium Declaration and set eight Millennium Development Goals (MDGs) to guide the implementation of the Declaration. All the goals are relevant to disability and three goals are of particular concern to PWDs and their families: Evolution of Concepts in CBR • Poverty

Achieve universal primary education. None of these goals can be effectively achieved without the inclusion of PWDs Promote gender equality and empower women. Eradicate severe poverty and hunger.

‘Inclusive’ commonly used with reference to educational provision that welcomes all children. It can also be applied to policies and services in health, skills training and employment and to community life in general. Evolution of Concepts in CBR • Inclusive Communities

The concept of an inclusive community means that communities adapt their structures and procedures to facilitate the inclusion of PWDs, rather than expecting them to change to fit in with existing arrangements. Evolution of Concepts in CBR • Inclusive Communities

An ideal CBR programme promotes DPOs: • to enable PWDs to understand disability and discrimination and • to know about and access their rights. • DPOs function at the level of various administrative boundaries: village / district / state Evolution of Concepts in CBR • Role of DPOs

DPOs have the right and the responsibility: • to identify the needs of all PWDs, • to maketheir needs known and • to promoteappropriate measures to address those needs Evolution of Concepts in CBR • Role of DPOs

DPOs need: • to educate all PWDs about their rights and • to advocate for action to ensure the realization of these rights Evolution of Concepts in CBR • Role of DPOs

DPOs are made to play proactive and meaningful roles in the initiation, implementation and evaluation of CBR programmes. • DPOs are recognized as a resource to strengthen CBR programmes. Evolution of Concepts in CBR • Role of DPOs

HOW BASIC PRINCIPLES OF A CBR PROGRAMME The principles are overlapping, complimentary and inter-dependent – they cannot be separated one from the other. Source: World Health Organization: Meeting Report on the development of guidelines for Community Based Rehabilitation (CBR) programmes : (1 st and 2 nd November 2004, Geneva, Switzerland)

Inclusion means the removal of all kinds of barriers which block PWDs from access to the mainstream. • Inclusion means placing disability issues and PWDs in the mainstreamof activities, rather than as an after-thought. • Inclusion means including all forms of impairment. BASIC PRINCIPLES OF A CBR PROGRAMME • Inclusion

Inclusion also means ‘convergence’ – that is, the involvement of PWDs in the campaigns, struggles and activities of other oppressed groups which are not centred exclusively on disability issues, such as children living on the streets, farmers, land rights and environment, women’s groups. BASIC PRINCIPLES OF A CBR PROGRAMME • Inclusion

Participation means the involvement of PWDs as active contributors to the CBR programme from policy making to implementation and evaluation, for the simple reason that they know best what they need. BASIC PRINCIPLES OF A CBR PROGRAMME • Participation

Participation also means PWDs being a critical resource within any CBR programme – providing training, making decisions etc. • It covers the participation of women in all processes and decision-making, and that of other groups who are typically not listened to or excluded. BASIC PRINCIPLES OF A CBR PROGRAMME • Participation

The benefits of the programme must be lasting. • The activity initiated through the CBR programme must be sustainable beyond the immediate life of the programme itself – able to continue beyond the initial intervention and thrive independently of the initiating agency. BASIC PRINCIPLES OF A CBR PROGRAMME • Sustainability

Strong links between GOs, NGOs, CBOs and DPOs will contribute towards sustainability. • This means that DPOs and SHGs are the hub of any CBR activity. BASIC PRINCIPLES OF A CBR PROGRAMME • Sustainability

Empowerment means that local people, and specifically PWDs and their families, make the programme decisions and control the resources. • It means PWDs taking leadership roles within programmes. BASIC PRINCIPLES OF A CBR PROGRAMME • Empowerment

The empowerment of women is central to any programme. • Empowerment necessitates capacity building – that is, the developing and using of the skills necessary to act with authority and responsibility, independent of the initiating agencies and CBR programme managers. BASIC PRINCIPLES OF A CBR PROGRAMME • Empowerment

Advocacy means the central and consistent involvement of PWDs and their families defining for themselves the goals and processes for poverty alleviation. BASIC PRINCIPLES OF A CBR PROGRAMME • Advocacy

Advocacy is a collective notion not an individualistic one. It means self- determination. • It means mobilizing, organizing, representing, creating space for interaction and demands. BASIC PRINCIPLES OF A CBR PROGRAMME • Advocacy

Any queries as of now? So far we have reflected on: • The emergence of the concept of CBR • The meaning (WHAT) of CBR • The Major Objectives of CBR • Evolution of concepts in CBR • Basic Principles of a CBR Programme: inclusion, participation, sustainability, empowerment and advocacy

ESSENTIAL COMPONENTS OF A CBR PROGRAMME • The programme should cover all types of PWDswho need rehabilitation services. • The programme should be part of mainstream development and have a multi-sectoral approach : including social integration interventions, health, education and economic programmes. • The programme should have access to or generate a good and effective referral system. • The programme should aim at full integration of the PWD into his / her community. • The programme needs to have committed and well trained community members as service providers. • The programme should have gender and disability focus and balance. • The programme should strike a balance between provision of service delivery and empowering the PWD, family and community through regular transfer of skills. • The programme should facilitate the formation and strengthening of the disabled people’s movement to ensure that the rights of the PWDs are not denied through advocacy at local, state and national level.

GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~ POVERTY ALLEVIATION WHO MATRIX

Multi-sectoral Support for CBR • Support from the Social Sector: Examples: disability pensions, technical aids and adaptations, housing, vocational training and employment, and co-ordination of referrals for individuals who require services from other sectors

Multi-sectoral Support for CBR • Support from NGOs and the local community: • Most communities have a variety of non-governmental organizations (NGOs) and groups that can contribute to a CBR programme.

Multi-sectoral Support for CBR • Support from the Health Sector: The Declaration of Alma Ata (1978) states that Primary Health Care (PHC) is the key to attaining health for all. It also states that the PHC needs to address the main health problems in the community, providing promotive, preventive, curative and rehabilitative services.

Multi-sectoral Support for CBR • Support from the Health Sector: PHC can play a major role in this context both as a provider and supporter: • Early identification of impairments and providing basic interventions. • Referrals to specialized services such as physical, occupational and speech therapies; prosthetics and orthotics; and corrective surgeries.

Multi-sectoral Support for CBR • Support from the Educational Sector: • The educational sector can make an important contribution to CBR by assisting community schools within the regular school system to become more inclusive. This involves, for instance, adapting the content of the curriculum and methods of teaching. Ensuring that classrooms, facilities and educational materials are accessible. • Children with multiple or severe disabilities who might require extensive additional support may access education through the use of innovative methods best suited to their context.

Multi-sectoral Support for CBR • Support from the Employment and Labour Sector: • Collaboration with the employment and labour sectors isessential to ensure that both youth and adults with disabilities have access to training and work opportunities at community level. Productive and decent work in a conducive environment is essential for the social and economic integration of individual PWDs. • Equal employment opportunities through national policies and legislation; open labour market; apprenticeships with master trainers or local businesses; on-the-job training; mentoring entrepreneurs with disabilities and providing advice on current and emerging skills requirements to vocational training centres; access to credit and self employment.

Multi-sectoral Support for CBR • Support from the Media : • All CBR stakeholders should work closely with the media to identify priorities and to provide relevant information.

MOVING TOWARDS AN EFFECTIVE CBR PROGRAMME • The following aspects of CBR need to be strengthened to make programmes more effective: • Community Involvement and Ownership • Multi-sectoral collaboration in CBR programmes • Involvement of DPOs in CBR programmes • Scaling up CBR programmes • CBR programmes to be used as an effective tool for poverty reduction • Evidenced based practice

Who Initiates CBR ? • Community action for CBR is often initiated by a stimulus from outside the community, most likely ministries or NGOs. • Following initial discussions with representatives from outside the community, ideally it is the community which decides whether CBR will become part of its ongoing community development activities.

COMPONENTS NEEDED TO BEGIN A PROGRAMME FOR THE REHABILITATION OF PWDs Look out for…. • An action area where the need is apparent. • A community which is receptive. • A resourceful and creative outside agency. • Persons with Disabilities who need the services of an external agency as well as the community for mainstreaming themselves, in order to set themselves up as contributors and not just recipients of service.

Challenges of CBR • Lack of understanding of concept. • Rapid turn over of civil servants. • Acceptance of CBR as a valid intervention. • Finance / Prioritization. • Poor Management / planning of CBR • Inter Ministerial Rivalry - Lack of communication • Evidence based facts not made available • Lack of co-ordination between the Government and NGO’s • Absence of a coherent community level strategy • Limited competence and capacity of decentralizing services • Limited models of good practices • Social welfare department often has a weak structure at community level • Government is preoccupied with basic needs • Governments do not include disability as a cross cutting issue.

that does not side stream PWDs We look forward to a tomorrow that includes PWDs in the mainstream as equal partners

A presentation of